Post-Traumatic Stress Disorder (PTSD)

Most people have distressing reactions after a traumatic event that ease over weeks. PTSD is when those reactions persist and cluster into intrusive memories or nightmares, avoidance of reminders, negative shifts in mood and thinking, and a heightened, on-guard state, lasting more than a month and interfering with daily life.

Trauma-focused psychotherapies (such as prolonged exposure and cognitive processing therapy) have the strongest evidence and are first-line. SSRIs and SNRIs are also effective and are often used alongside therapy, especially when symptoms are severe. The right starting point depends on the case.

Yes. SSRIs and SNRIs can reduce the core symptoms and the depression and anxiety that often accompany PTSD. Medication works best as part of a plan that includes trauma-focused therapy rather than on its own, and whether and what to prescribe is decided case by case.

Prazosin, a blood-pressure medication, is used off-label to reduce trauma-related nightmares and improve sleep for some people with PTSD. It does not treat PTSD as a whole, but it can help a specific and disruptive symptom; it is started low and adjusted with monitoring, and it is not right for everyone.

I begin with an evaluation that takes the trauma history at the person's pace and screens for the conditions that commonly travel with PTSD (depression, substance use, sleep problems). The plan typically combines medication with referral to a trauma-focused therapist, with visit cadence matched to the clinical picture, and is built case by case.